HS660 Capstone Thesis - The Elderly

Aspects of the Elderly/ Townsend 1
Aspects of the Elderly Population
HS660 – Capstone Thesis for M.S. Human Services
Albertus Magnus College
Bonnie Lea Townsend
May 01, 2013

The elderly population is growing, especially with the advent of the Baby Boomer
Generation. It is appropriate to discuss the cares and concerns of this population and how to care
for them, since getting older affects everyone in different societies. Among physical abuse, drug
and alcohol abuse, Alzheimer’s disease and dementia, ageism, well-being, retirement, cultural
competence in healthcare, sexuality and bereavement, there is increasing awareness of needs and
resources to aid the aging. Even though becoming elderly seems grim, learning how to cope
being in and support for this age group is also increasing, as well as inspiring.
First: As elders in many societies are honored, many in today’s society play an important
role in providing support, spiritually, socially, physically, and even, economically. In ancient
pre-history, however, it was rare that people lived long enough to become grandparents. Cultural
Anthropologists question when the elderly became prevalent, and if there is a possibility of a
cultural shift toward shaping modern art, language, and/or biology and behavior. Analysis of
Neanderthals was conducted by anthropologists in attempt to understand the evolution to Modern
European culture, and the relation between adult survivors and sophisticated traditions.
“Neanderthals (Neander-thal, the ‘th’ pronounced as‘t’) are our closest extinct human relative”
(“Human Evolution Evidence”, n.d.). Their facial features were similar to modern man. The
bodies were shorter and stockier, adapted for cold environments in the geographic areas that
became northern Europe and southwestern to central Asia, existing between 200,000 to 28,000
years ago. Their brains were as large as ours today, which allowed them the ability to know how
to make and use tools, build fire and live in shelters they built, wore clothing, and were
sophisticated enough to purposely bury their dead. Some ancient cultures that live with their
entire history in their minds and memories by telling the younger ones in their tribes through

stories, and by doing this, preserve their history and culture; tell how they came to be; telling
where and how to find food; their politics, other groups; songs and other traditions.
The findings seem to establish that “grandparent- aged individuals became common
relatively recently in human pre-history and that this change came at about the same time as
cultural shifts toward distinctly modern behaviors…” (Caspari, n/d). This behavior includes
developing a sophisticated way of communication through the use of symbols, and is considered
pre-writing. The social interactions of a people that learned how to use a symbol system, like
pictographs, profoundly affected them as they used these to tell stories and events, thought of
today as art. This may have improved genetics, as they learned how to consider what signifies
danger, what means abundance, and also caused intellectual brain functions to grow as they
adapted. “This surge in the number of seniors may have been a driving force for the explosion of
new tool types and art forms, including clay figurines, which occurred in Europe…” Caspari,
n/d).
Subsequently, in an effort to discover changes in human evolution toward longevity,
researchers used what is called wear-based seriation (sic) in the teeth, and determining at what
age molars came in, they determined how many individuals lived to be of old age. Along with
the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany, results and
validation of findings showed that tooth-wear from fossils of the Krapina Neanderthals, they did
not live past the age of thirty years. A few lived to around forty years when they died, thus
showing that life was very short 600,000 years ago.
The problem was that most of the fossils cannot be reflective of large populations
because; numbers of found and preserved fossils at a site were small. Also, because the small

numbers made it difficult, the statistical data could not reliably ascertain how old they were when
they died. However, the researchers, “…observed a small trend of increased longevity over time
among all samples, but the difference between earlier humans and the modern humans of the
Upper Paleolithic was a dramatic fivefold increase…” (Caspari, n/d).
Continuing, the scientist learned that there was a surge of evolutionary growth at some
point, however, the question remained as to what exactly caused the surge: biology or behavior
considerations. Environment could have also played a role. For example: In warmer climates,
such as in Asia, there was more vegetation, compared with the Ice Age of Europe, therefore;
there were more survivors and longevity into grandparenthood. Caspari concludes by saying,
“Growing population size would have affected our fore bearers another way, too: by accelerating
the pace of evolution…more people mean more mutations and opportunities for advantageous
mutations to sweep through populations as their members reproduce” (n/d).
Also historically, “Advancements in sanitation and other public health measures…”
(Timmreck, 2003, p.12), influenced hand washing, clean water supplies, cleaning up garbage and
sewers, along with washing bed sheets and towels in hospitals and changing bandages. It
controlled communicable diseases and slowed the spread of pathogens, making it possible for
people to live into their old age. Many still became ill, however, survived, and needed care
outside a hospital. As life expectancies rise, the older the elderly people become, statistics show
from the Federal Interagency Forum on Aging-Related Statistics (FIFARS), taken in the year
2000. “For example, in the United States, the average 65-year-old man lives to about age 80, but
once a man reaches 80, he is likely to live to be 90” (Boyd & Bee, 2006, p.166). Life
expectancies vary by cultural groups, as well as with women, who tend to live longer than men.
Demographics illustrate that by the year 2050, the senior population over age 85 will be more

than 19 million in the United States. In 2008, the first Baby Boomer Generation became 62 years
old.
The United States government in the 1950s and 1960s, facing “many health care
dilemmas” (Timmreck, 2003, p.12) eventually realized that support services through laws and
funding were needed because housing for the elderly were meant to care for at least ten or more
patients at a time, and became the blame for many elderly abuse stories. In 1961, Congress held
the First White House Conference on Aging, and in 1965 the Older Americans Act was passed.
Area-wide Model Projects were developed through monetary funds that were allocated. They
evolved into the Area Agency on Aging, and administered by local city governments. Other
significant dates: “1972 – Formula for Social Security cost-of-living adjustment established;
Social Security Supplemental Security Income legislation passed; 1974 – Employee Retirement
Income Security Act (ERISA) passed; IRAs established; 1975 – Age Discrimination Act passed;
1978 – 401(k)s established” (Wallman, 2012).
In a study by FIFARS, “a majority of older adults across all three subgroups [young-old,
65-75; old-old, 75-85; and oldest-old, 85 and older] regard their health as good” (Boyd & Bee,
2006, p. 168). The data used Non-Hispanic White, Hispanic, and Non-Hispanic-Black subjects.
Non-Hispanic Whites displayed higher percentages. It also ought to be considered that health
may include the ability to perform activities of daily living (ASLs), cognitive health and mental
health. The maximum life span of humans seems to be up to 120 years old. This may be
influenced by genetics, such as what is in the DNA of an individual. It could also be influenced
by maintaining mental and physical health, with doing such activities as putting puzzles together,
solving word searches or Sudoku, playing chess, being socially involved to keep intellectually
engaged, as well as a good diet and exercise.

However, even within performing tasks, an elderly individual may still eventually suffer
from Alzheimer’s disease or other dementias. Alzheimer’s is a slow progression that is signified
by memory loss, repetitive conversation, loss of words, and disorientation. Recent memories
become difficult to retain, however, crystallized memories may be retained longer. It is
suggested that crystallized information may find alternative pathways in the neurons. In
diagnosing Alzheimer’s disease, it cannot be definite that an individual had it, until an autopsy of
the brain is performed. This is because only through an autopsy, that the conditions of the neuro-
transmitter fibers can be examined. While an individual is still alive, diagnosing Alzheimer’s is
complicated “by the fact that nearly 80% of elderly individuals complain of memory problems”
(Boyd & Bee, 2006, p.181). There are drugs available that seem to increase some activity in the
brain, slowing the progression of Alzheimer’s. Although heredity may be a factor, there are also
variables in its effects, such as, overall health and heavily drinking alcohol.
Unfairly, it seems, in life when as people become older, so are the younger groups who
take over positions once held by the older groups, in jobs or financial decisions of their aging
parents. The stigma of becoming elderly seems to be that one becomes less self-sufficient and
able to handle complicated decision making and anything else the ever more complicated world
has to offer. Therefore, they are thought of as becoming weaker in mind and body, and they are a
burden to other family members and society, including nursing home personnel and caregivers.
In most cases they become depressed.
Consequently, elderly patients/clients are at the mercy of younger personnel, who are
selfish, untrained or tired. This possibility could be experienced by those who are developing or
have developed dementia or Alzheimer’s disease. Because of these factors, many elderly people
fall victim to some type of abuse: psychological, physical, sexual, and financial fraud, and is a

form of ageism. Financial fraud could be brought on from irresponsible family members or
scams in the mail, at the door, by phone or Internet. Deputy District Attorney Paul Greenwood is
not only aware of the problem, he heads San Diego’s Elder Abuse Prosecution Unit, which
specializes in the most difficult of cases in elder abuse. Because some elderly victims are not
able to communicate, and there may be little evidence, “he knows that with some senior victims
a few months can equal a lifetime” (Moore, 2012).
In San Diego County, California, it has been reported that many victims are not able to
discuss their cases because of dementia or Alzheimer’s, which affects memory, perception of
ideas, and articulation. As Baby Boomers become older, the number of cases being reported of
abuse to the elderly is increasing. More to the problem; there are still police agencies that are
unprepared for the increase, and routine or not routine cases which involve the senior age group
require specialized training, which many smaller local agencies may not have had. Unskilled
officers may not know what to look for or appropriate questions to ask. More problematic is, if
the case goes unreported at first, either because the senior person cannot report it or someone is
being protected. Many senior parents still feel responsible for their adult children’s behavior.
Statistics measuring elder abuse and neglect do not show complete numbers, although incidents
and investigations are apparently rising.
A unit that has had special training knows how to freeze bank accounts, work with Adult
Protective Services, and have the ability to obtain medical records for investigation. Obtaining
medical records is important for determining if the victim has dementia or Alzheimer’s disease.
The effects of Alzheimer’s sometimes prevents the elderly who have it from understanding
concepts on a day to day basis, and sometimes hourly. They can confuse what they have seen on
television, recalling it and thinking it was something that must have really happened, and report

it. Determining what is real requires special training to recognize the signs, and if the facts do
determine it, the officer knows how to handle the case, and it is in confidence. If there seems to
be flags raised for abuse or neglect, “…police, prosecutors, the courts, and protective service
agencies are all understaffed, under trained and underfunded” (Moore, 2012), disabling the
judicial system.
Positively, however, Candace Heisler, a retired assistant district attorney, who is an
authority in investigations with elderly victim cases in San Francisco, believes that using
resources available, for example; a team approach, rather than unilaterally, gives a greater chance
for support towards helping against abuse. She advocates that police meet and communicate
within the community. Because situations do occur, a community based approach is the best way
to help a victim. For example: if an elderly person has not been seen in their local library, or
local store for a time, and it’s usual for them to be seen there, and it is known that they have not
gone on a trip, it may be suspected that something has happened to them. Communication and
resources are the most helpful in this regard.
Moreover, elderly Americans are not immune to the problems of drug abuse. There are
indicators that show how prescription drug abuse is a significant problem in the United States.
Elderly people are usually prescribed long-term and multiple prescriptions “which could lead to
abuse or unintentional misuse” (Volkow, 2006/07). It is suggested how necessary it is to have
physician education. Considering young people who need to take therapeutic drugs for ADHD or
pain, scientists are working how to produce formulas so that the dosages have the value they are
supposed to have to be effective while minimalizing the potential for abuse and addiction.

“The recent increase in the extent of prescription drug abuse in this country is likely the
result of a confluence of factors…” (Volkow, 2006/07), including such elements as, increases in
written prescriptions, aggressive marketing, availability, and with desire and acceptability,
socially, for taking a drug for any condition. Among the special populations, such as elderly
Americans, they are prescribed long-term medicines and usually several at a time for practical
purposes. However, since they consume many, there could be drug interactions with over-the-
counter medicines and dietary supplements, such as vitamins.
As people become older, their ability to metabolize drugs change and can become
susceptible to side effects that become toxic to their system. According to Volkow, elderly
people who are prescribed “benzodiazepines such as Valium, Librium and Xanax are at
increased risk for cognitive impairment, leading to possible falls as well as vehicular accidents”
(2006/07). She suggests that further education for physicians as an intervention that might not be
aware of the effects of these drugs on the elderly is necessary to prevent harm to them. The
National Institute on Drug Abuse (NIDA) (Volkow, 2006/07) attempts to identify and recognize
trends in abuse and misuse; attempts to educate the general public; and monitors healthcare
providers and physicians, as well as develop strategies to prevent addiction and its form of
treatment.
Further, since the older population is becoming more ethnically diverse, and with the
advent of migration, chances of the elderly in nursing homes, assisted living facilities, and home
health care, of being cared for by a health care worker with a different cultural background
increases. To help identify the problems facilities and clients/patients present to prevent harm
and abuse, communication is the key concept to management in elder care. It challenges workers
in: understanding; able to read and write proficiently in English; as well as meeting religious

needs of the patients. This brings forth the topic of cultural competence in the work place and
long-term care facilities. “Much of the literature regarding cultural competence in healthcare is
explicitly limited to the need for professional care givers to respond to the diversity within the
client population…” (Parker, 2010/2011). However, the numbers of diverse professional
healthcare workers has increased, yet cultural competence among them toward their patients has
not received the attention it needs. Many professional healthcare agencies have not caught up to
the present, not thinking about cultural competence. “Yet without attending to the increasing
diversity in both groups, it is unlikely that efforts to improve cultural competence will be fully
successful” (Parker, 2010/2011).
According to Parker (2010/2011), demographers using census data taken in 2000, they
believe that between the years 2000 and 2030, Hispanics will increase by 328 percent, Asian and
Pacific Islanders by 285 percent, African Americans by 131 percent, whereas Whites are only
expected to increase by 81 percent. Also, according to data put together by Wallman (2012),
about 28,000 patients in 1992 stayed in skilled nursing facilities, however, by 2009, there were
around 80,000 patients, while; between 1992 and 2009, the length of a hospital stay decreased
from 8.4 days down to 5.4 days. These numbers also affect the demographics and environment of
nursing facilities, as there is a decrease in the numbers of whites in the facilities, whereas, the
number of other cultural groups are increasing. “A recent review suggests problems exist in
delivering the best quality care…” (Parker, 2010/2011) to meet all the needs of diverse cultures,
including: language, cultural and religious and spiritual needs. The food menu is another issue
that ought to be considered.
Because of racial or ethnic diversity in the healthcare workplace, there is a concern over
the potential breakdown in communication, inviting care worker groups to become isolated and

disconcerted from a team-approach. This issue causes an unsatisfactory work environment. Non-
verbal and tonal communication among a diverse supervisor – to- worker – relationship could
cause awkwardness and misunderstanding. Especially, suggests Parker (2010/2011), when
diverse groups are under-represented in management and higher-level professional staff in
facilities where they are in white, middle-class communities. The older population
patients/clients and care workers retain past thinking, beliefs, biases and assumptions of other
cultural groups, making it difficult to work past judgments.
Gerontology is the scientific study of aging, and is usually thought of as people who
become depressed, grumpy, becoming closer toward death. In the article, Ageism: Prejudice
Against Our Feared Self, (Nelson, 2005) it discusses how little attention has been paid toward
prejudice against age. Most people, when considering a stereotype consider racism, sexism, or
classism, however ageism is not well known. While finding resources to research for his article,
Nelson writes, “ A search for “racism” yielded 3, 111 documents, while a search for “sexism”
yielded 1, 385 documents, and a search for “ageism” produced only 294 documents” (2005).
Nelson continues by saying the responsibilities of older Americans have been taken away; they
have been marginalized, as well as institutionalized, losing power and dignity.
“In most prehistoric and agrarian societies, older people were often held in high regard”
(Nelson, 2005). In these societies, having lived 50 years was considered old age. Nelson (2005)
suggests that the printing press has belittled the need for the elderly to maintain the family
history by the stories they told, and the need for mobility for work purposes made it inconvenient
to be old. “Older men were more likely to live with their spouse than were older women”
(Wallman, 2012). Older women were more than likely as older men to live by themselves,

mostly because their husbands have passed. In comparison, cultures differ in that Asian, older
Black and Hispanic women tend to live with other family members than non-Hispanic Whites.
Furthermore, medicine and nutrition had improved the extension of life, however, causing
society to consider older people to be burdens financially and a requirement for someone to stay
with them.
Older people are thought to have slower cognitive functioning, therefore, younger people,
including nursing personnel, tend to speak to older people with “baby talk”. This is unfortunate,
especially with those who accept it, because they are put into a dependent role when decisions
become the responsibility of the younger caretakers. In the work place, older individuals become
dependent on younger supervisors; especially when in a position that require “the ability to adapt
to changes” (Nelson, 2005) in technology is more important than experience. “Cross-cultural
research also indicates that both primary and secondary baby talk appear to be universal,
occurring in small preliterate societies as well as modern industrialized cities” (Nelson, 2005).
Secondary baby talk is so termed from primary baby talk when individuals speak to babies.
However, individuals who use the same kind of speech to pets, inanimate objects and other
adults are using secondary baby talk, and it is considered insulting. Because individuals use it to
speak to an older adult, it has the same connotation of being needy and dependent on them,
similar to a child, and therefore, ageist.
There is evidence that suggests that many therapists treating older adults tend to have
stereotypical views, being ageist. The stereotypical views are that they either speak very little
about their problems, or too much. A problem occurs when psychiatrists, especially those who
do not have the patience, will over- or underestimate, assuming problems incorrectly. They
prescribe drug therapy more often than psychotherapy to older adults than younger individuals,

especially when depression is considered the primary problem. “Because older adults frequently
present with health problems, this may bias psychologists in assessing the presence and extent of
any mental health problems” (Nelson, 2005). Ways that health care providers in the medical and
psychological field could change bias and ageism, would be to: assess their attitudes toward
older people; confront issues of ageism where and when it arises; training and education toward
what occurs as people age, and by instituting geriatric programs in hospitals and clinics, to gain
thorough knowledge.
Thorough knowledge and awareness is important when it comes to elder abuse,
perceptions of old age by younger people, and ageism. For example, Okun & Kantrowitz (2008)
discuss ageist counseling: a 69 year old woman seeing a 40 year old therapist, told her how she
would like to go back to school to earn an M.S.W. degree. The therapist told her that volunteer
work would be better suited for someone her age. Belief in this attitude could be a lost
opportunity, because “the therapist told her she was past that stage of life” (p.290). Because
seniors spend much of the time with their T.V. on, they are exposed to negative portrayals of
elderly people, and thus, develop negative views toward aging. A solution toward this exposure
and negative thinking is to develop an intervention “to encourage older adults to think critically
about the ageism present in each program they are watching” (Nelson, 2005). More positive
attitudes could be linked to be more present in the micro level as well as the meso level.
While death is an uncomfortable subject for some, death comes easier for some “[a]dults
who believe that their lives have had some purpose or meaning…[are]…less fearful of death, as
do those who have some sense of personal competence” (Boyd & Bee, 2006, p.231). They may
feel a personal self-worth and feeling that their life goals had been fulfilled. In preparation for
death, adults who feel they are getting closer toward the end of life may make life-style changes,

have a desire to contact and be with loved ones, or attempt to complete projects. They may
genuinely accept their life and the responsibility of death by purchasing life insurance and
provide a living will to ascertain health care desires to professionals and the individual’s family.
“In the year following bereavement, the incidence of depression among widows and
widowers rises substantially…” (Boyd & Bee, 2006, p.241). Depression seems to occur more
during the illness of a spouse, rather than after the spouse has died. However, in terms of
preventing long-term feelings of grief when a loved one dies, “some research suggests that the
“talk it out” approach to managing grief can be helpful in preventing grief-related depression”
(Boyd & Bee, 2006, p.244). This approach can be handled by sharing experiences within support
groups, and within the family context, whereas, everyone can share stories of their loved one
who passed. The Bible, Jewish Scriptures, and the Quran give the impression that once a
person’s life has been fulfilled, then death will come. Religious adults who seem to have a more
firm foundation are less afraid of the coming death. Employers would support the loss of an
employee’s spouse by giving them time to grieve and the time would be beneficial for physical
and mental health for the worker, as well as the employer.
Culturally, there are differences in the way death and bereavement are handled and
exhibited. For example, in the Jewish Orthodox tradition, the men might not shave and let their
hair grow. This may lead counselors to believe he is severely depressed, however, “observers
who are unfamiliar with Orthodox Jewish mourning practices might conclude that those who
follow them are exhibiting pathological rather than normal grieving” (Boyd & Bee, 2006, p.
243). It is suggested that counselors learn about the traditions and cultural beliefs, to prevent
misunderstandings about behavior in a cultural tradition.

Exclusive of events such as abuse and death, there is hope for patients who have suffered
a stroke. A stroke can disable the body some-what, however, in Keene, New Hampshire four
subjects participated in a wellness yoga program to increase activity and as an alternative
exercise program. Outcome measures were retrieved through scales and tests. Yoga is a Sanskrit
word meaning “to yoke” or “unite”; in which the purpose is to unite the body, mind and spirit:
“Practitioners of yoga therapy integrate yoga concepts with western medical and psychological
knowledge…” (Bastille & Gill-Body, 2004). Ages of the subjects range between 49 to 71 years.
Although there were variables in baseline scores, there was also some improvement in balance
and flexibility.
For background information, people who have had impaired health due to reduced
activity because of a stroke and are chronic (affected for more than nine months), were subjects
in the study. “Stroke is the leading cause of adult disability in the United States, with more than
4.7 million people who have had a stroke alive in the United States today” (Bastille & Gill-Body,
2004). The neurological deficits that occur due to strokes can be mild to moderate, and are
associated with other health problems, such as cardiovascular issues and falls. There is an
increase of falls in the home after a stroke, particularly within the first six months of being
discharged from the hospital. In hopes of improving the quality of life of those who survived
having a stroke, exercise programs have been designed for the purpose of maintaining physical
health and balance.
According to Bastille & Gill-Body (2004), there is a plateau of recovery within functional
and neurological abilities, from a majority of people who have had a stroke, whereas;
improvements beyond that point are not expected. However, it has been discovered through
investigation that improvement is possible in the muscle force, balance, aerobic capacity, and

timing and mobility in those “with chronic poststroke hemiparesis” (Bastille & Gill-Body). In
reference, the National Stroke Association says that hemiparesis is the most common impairment
to movement, and refers to “one-sided weakness”. Symptoms include: loss of balance; difficulty
walking; impaired ability to grasp objects; decrease in movement precision; muscle fatigue; lack
of coordination. It can affect either the right side or the left side of the brain; however, if there is
an injury to the left side, which controls the ability to use language and speech, the right side
carries the hemiparesis, because the ability to express oneself and to comprehend language is
affected.
Likewise, injury to the right side of the brain which controls the process of how people
learn, non-verbal communication, as well as other behaviors, causes left sided hemiparesis.
Because of damage to the right, the left is weak and can result in memory loss, attention span
loss, the inability to sense cold or hot, or if they are grasping an object, as well as spatial
disability. Other types of hemiparesis can affect the cerebellum, the lower part of the brain,
causing ataxia – the inability to coordinate movement; pure motor hemiparesis, which causes
weakness in the facial muscles, arms or legs; brain stem hemiparesis causes difficulty in
swallowing.
Furthermore, treatment plans for stroke survivors can include a psychiatrist, physical
therapist or occupational therapist. Among the methods of treatment, according to the National
Stroke Association (NSA), include: modified constraint-induced therapy; electrical stimulation;
cortical stimulation; and motor imagery. In terms of management, the NSA suggests using
assistive aids at home, as well as performing exercises and making life-style changes. In
consideration for making a life-style change, yoga is suggested as a form of therapy that
practices changes in mental attitudes toward the goal of enlightenment and awareness of oneself.

There are eight forms of yoga, encompassing eight elements, “known as the eight-fold path of
yoga [Hatha]”, (Bastille & Gill-Body, 2004), and includes moral disciplines, self-restraint,
breathing, physical poses, sensory inhibition, concentration, meditation, and a blissful state.
“Yoga therapeutics is defined by International Association of Yoga Therapists as the
application of yoga for health benefits” (Bastille & Gill-Body, 2004). Yoga usually involves
postures, stretches, relaxation, balancing and breathing, as well as a particular diet, and could be
adapted as an alternative exercise program for people with neurological issues such as multiple
sclerosis. Stroke survivors may also benefit. However, according to Bastille & Gill-Body, there
have not been any studies performed to investigate “the effects of yoga on people who have had
a stroke or hemiparesis” (2004), hence, the preliminary investigation in the single-case study.
The study was performed only after collecting data, proper education of the data
collectors, calculations of scores. Guiding the four subjects using a certified yoga instructor also
included instruction about exercises and after a period of time, the subjects were questioned after
each session. The scores seemed to indicate all subjects made improvement, physically and
emotionally. One subject reportedly made improvement in memory and nevertheless, all four
made positive changes. The outcome of the study resulted in suggesting that a yoga-based
exercise program benefits stroke survivors.
Many older people still in the workforce, including one pediatrician in Georgia who
retired in 2001 at the age of 103, aren’t prepared for retirement. Getting ready to retire
intellectually and financially takes grace, as one doctor suggests. Dr. Linda Lee, director of the
Centre for Family Medicine Memory Clinic in Ontario, Canada says, “I think physicianhood is
unique in the sense that much of our identities are entwined with our work” (Collier, 2011). Lee

is concerned that there are physicians who continue working because they are dedicated to their
jobs, even though their cognitive skills begin to decline.
“It would be better for those doctors, not to mention their patients, if they learned how to
retire gracefully instead of pushing on until their skills degrade to the point of incompetence”
(Collier, 2011), says Dr. Lee. Older physicians, she continues to mention, have crystallized
intelligence which enables them to draw from previous knowledge when making a diagnosis.
However, a person who is of senior age takes longer to complete tasks. A younger person has
fluid intelligence, which enables him or her to learn new knowledge and is better at solving
problems logically. Psychologically speaking, retired physicians would have to give up
intellectual conversation, and possibly how they stand in their community, which ultimately
changes how they think of themselves. “They must also learn to re-structure their lives, which
will no longer follow the hectic cycle that once filled their days” (Collier, 2011). The statement
could be said for all older people still in the workforce, who, to them, find retirement means
moving on to other activities, keeping their days filled.
The older population is postponing retirement, due to improved health and longer lives.
Although the elderly can bring wisdom and knowledge, this could also be fulfilling for them in
terms of the social aspect and self-esteem. However, there are still challenges that they face in
terms of age discrimination and the fear of lessening cognitive and sensory ability. Within the
adversity and work-place readjustment, the older person can continue to be successful and
maintain positive well-being, through accessing resources.
The participation of the workforce of men and women aged 55 and over, according to
Wallman’s (2012) data, shows: For men in the year 2001: 74.9 percent, age 55-61; for women,

58.9 percent, same ages, 55-61, however; by the year 2011, the percentages were 75.4 for men,
and 65.3 for women. Both had increased in ten years, with women showing more of an increase
than men since 2001, however, there are still significantly more men in the work force than
women, up through 70 and over.
The workforce over the age of 65 years has increased in recent years, from 14% in 2003,
to 17.4% in 2010, according to the U.S Department of Labor. “The Age Discrimination Act
(ADEA) of 1967, amended in 1978 and 1986, protects workers older than the age of 40 years”
(Sterns & Dawson, 2012). The Job Training Partnership Act and the Older Americans Act
recognize that people age 55 years old and older are older adult workers. Functionally, as
individuals grow older, their performance on the job changes, as they experience biological,
physical and psychological changes. Although experience and wisdom can increase, physical,
biological and cognitive abilities can decrease.
“Ageism usually refers to the problems of being too old rather than to the problems of
being too young” (Okun & Kantrowitz, 2008, p. 290). If they are to remain on the job, alterations
can be made in terms of work schedule and assistive devices. A work environment that is
flexible toward older workers, especially if they have health –related issues, can be established.
If an older worker becomes ill, such as, suffering from a stroke, they are less likely to return to
work, because it has been found that support systems are less likely to be there at the workplace.
However, modifications can be made to accommodate them, such as allowing them to sit at a
work station, rather than stand. Relatively speaking, employers may not encourage older injured
workers to return to work, because of services they may need. This type of environment is not
considered “age friendly”, and may be considered a concept of elder ageism.

Interestingly, “resilience has been conceptualized in the literature as both a trait and a
process” (Sterns & Dawson, 2012). Changes can be stressful, not only biologically and
psychologically, but at home, as well as the work place. If an individual has the resilience and
flexibility to work through changes, continuing to work as one becomes older can be successful.
Resilience is “the ability of an individual to adjust to adversity, maintain equilibrium, retain
some sense of control over their environment, and continue to move on in a positive manner”
(Sterns & Dawson, 2012). A person’s disposition may be influential toward how they interpret
and consider life and the work environment; how they relate to and support others; as well as feel
they can accept support from others within the social aspects, including from younger workers
and management. Problem-solving abilities in certain situations, and being able to define
themselves as to what they feel their life-purpose is are some of the aspects that reflect resilience.
Because of problem-solving difficulties, it is suggested that older adults, when choosing a
new vocation, look for positions that require only crystallized intelligence, instead of requiring
fluid intelligence. This is to compensate for possible cognitive decline. An older worker who has
had years of experience in management would retain crystallized intelligence, as well as wisdom,
further crystallizing a normal comfort-level strength, compensating for change. However, “some
of the same personality traits, such as openness to experience, have been linked to resilience…”
(Sterns & Dawson, 2012). Openness to experience includes when older workers consider
retirement from a position long-held by them, in order to take on different activities, satisfying
other internal personal aspects of themselves. The ability to consider other and new options for
them-selves, can also be a resilient approach to life, such as teaching what they know or going
for further education. Otherwise, an individual who does not have resilience may not recover

from the shock of retirement, feeling as if they have nothing to do or nowhere to go after many
years in a career.
In a more personal matter, intimacy is a fact of life. Resilience in relationships is learned
through how one responds to another. However, negative stereotypes can affect how one regards
themselves. Healthy attitudes towards the self include attitudes toward ethnic minorities or
sexual orientation and how one identifies him or her-self. Older Americans, aged 65 and over,
termed the Baby Boomer generation, challenge mental health professionals as to what they know
about an individual’s identity, in regards to socioeconomic status, sexual orientation, HIV/AIDS,
religion, gender. race, and so forth. It is important for counselors to be flexible, non-judgmental,
and have the training that covers different life-styles.
“The literature on older adults and sexuality suggest that culturally sensitive counseling
may give older adults an opportunity to express sexual concerns and promote healthier attitudes
toward sexuality” (Muzacz & Akinsulure, 2013). Counselors want to encourage baby boomers,
which are fast becoming the largest elderly population in America, to maintain healthy sexual
activities. From a survey completed by the American Psychological Association (APA), it was
found that out of 70 percent of psychologists who have clients aged 65 and over, 30 percent
received graduate level training in working with this population, and only about 20 percent
worked in an internship or practicum that dealt clearly with elderly Americans.
“Besides fulfilling our responsibilities to acknowledge all aspects of our client’s cultural
identities, it is essential to consider older adults’ needs and desires in all areas of functioning –
physical, emotional and social/ interpersonal” (Muzacz & Akinsulure-Smith, 2013). In effort to
promote healthy attitudes towards sexuality within ethnic or minority groups, counselors must

understand that sexual desire does not always decrease with age; however, information on sexual
desires in older adults seems to be lacking. Since, “[p]sychological studies of sexual activity
have younger participants…”, (Muzacz & Akinsulure-Smith, 2013), current research assumes
that desire and activity will slow down or stop completely as one ages because of changes that
occur, or side effects of medication.
It is popular to believe that widows or widowers lose their desire after a time if they are
not active. “…normative aging [in studies] do not discuss sex” (Muzacz & Akinsulure-Smith,
2013). The authors discuss the myths of sexuality in older adults, by mentioning perception and
how others perceive them. Stereotypes of sexual activity seem to be acceptable for young people;
however, counselors ought to be wary and to concern themselves against the beliefs that
comprise ageism. Ageism is an influential factor in depression. This also causes a dilemma for
“the gay male community”, Muzacz & Akinsulure-Smith (2013) suggests. Wherein, physical
changes in their appearance causes them to perceive them-selves as less desirable and
unattractive. Social awkwardness toward how one perceives them-selves causes people to not be
entirely honest when discussing this subject with counselors.
It is imperative for counselors to be aware that clients, who cannot discuss their sexual
desires in front of counselors, may cause underlying issues and misdiagnosis or untreated
problems related to depression. Getting clients to attend support groups for menopause, HIV, or
erectile dysfunction, can be helpful, either individually or through family therapy. In dealing
with these issues, older individuals might feel better about having a community or group to share
what they are experiencing.

There is no doubt that as the body ages there are physiological changes that cause needs
to change. Physical changes are more obvious, however, seen as negative by younger people
who naturally would not be ready to see themselves in that way someday. Needs for older people
seem to be undermined as one ages; causing self-esteem issues, and to be able to obtain
consistent services. “Advocacy seems to be one of the best strategies…” (Okun & Kantrowitz,
2008, p. 290): People who are in the Human Services and helping fields ought to learn about
needs assessments for program planning services, programs and resources available in their
communities, locate and identify people within certain organizations, and to become familiar
with the procedures of Medicare, Medicaid and Social Security.
“Life is a series of trade-offs, with some parts of you [in adult life] becoming more
present and competent…” (Hudson & McLean, 2006, p.89). Retirement, in context, can bring
opportunities toward new work, time with family, travel, hobbies and leadership roles. People in
their sixties tend to reduce unnecessary things having the desire to simplify their life, and deepen
their relationships and spiritual meanings. While radio programs like the “Jack Paar Show” and
listening to Kate Smith sing offered a social connection to the world in the past, since the
Internet has improved, people have the ability to search for resources about health and
healthcare, abuse, Alzheimer’s disease, counseling and other community resources. Within the
use of social media websites such as Facebook, they’ve discovered that they can use it to find
and maintain relationships with friends and family in other towns, cities and countries. “Many
elderly individuals also claim that the Internet world reconnects them with people from different
age groups in different cultures” (Ting-Toomey & Chang, 2005, p. 320).
In a table provided by Wallman (2012), from ages 55 – 64, people spend on average of
0.6 hours per day socializing and communicating, while 65 – 74 spend on average of 0.7 hours,

and 75 and over go back to 0.6 hours, however; TV watching for 55 – 64 age group is around 3
hours per day, while for the 75 year old age group spends 4.4 hours per day on average.
Participation in sports, exercise and recreation, averaged 0.3 hours, 55-64; 0.3 hours, 65-74; 0.2
hours, 75 and over; relaxing and thinking: 0.3 hours, 55-64; 0.5 hours, 65-74; 0.7 hours for 75
and over; reading averages: 0.4 hours, 55-64; 0.6 hours, 65-74; 0.9 hours for 75 and over; and
lastly, other leisure activities that include playing games, using the computer, arts and crafts as a
hobby, arts and entertainment other than sports, and travel: 0.7 hours, 55-64; 0.8 hours, 65-74;
and 0.8 hours for 75 and over. The data is collected from non-institutionalized, civilian
population.
Those transitioning into their seventies would find it more difficult, however, Hudson &
McLean (2006) suggest that the significance is great and “to remain an on-purpose person with a
proactive agenda” (p.101). Although, living into the eighties and nineties is possible, however,
still few compared to younger age groups, they “are recognized and consulted for their wisdom,
integrity, and cultural perspective. They often inspire others with their optimism and hope”
(Hudson & McLean, 2006, p.102), human stories and resilience.
Because people learn who they are, and what they are capable of being through
relationships, this author has learned patience, active listening, and graciousness. This author had
many fortunate opportunities to meet and work with inspiring elderly clients as a healthcare
worker: My grandmother who grew up in the early nineteen- hundreds, told me stories of her
youth with her brothers and sisters, and how they would take, without permission, the silver
platters in the house and use them as sleds in the snow; another woman client was a floral
arranger to wealthy and celebrated people, and who introduced me to one of her clients,
President George Bush’s sister; a male client whose uncle was in Vaudeville and Hollywood and

he, himself traveled the world as a salesman to major companies; a woman whose husband was a
well-known drummer and invented a special drum pedal, still used by drummers today; and a 92
year old woman, who this author enjoys the intimacy of putting puzzles together with her.
In conclusion, as people age, not only do they carry the issues of becoming older, but
they also bring internal and external elements with them, negatively or positively. Negatively,
issues that have never been resolved continue to be carried with them. Ageism is a huge,
however, under-discussed subject, when considering housing and living arrangements, health
care, counseling, family and community. Although, old age is seen as tragic and stereotyped, it is
not always the case. It is also a community. Data presents its own facts, significantly different
from other populations. Positively, elders have shaped societies and culture through music,
language, spirituality, art and behavior. It presents an opportunity for those in the caring field to
offer support and learn.
With the advent of physical abuse, drug and alcohol abuse, Alzheimer’s disease and
dementia, ageism, well-being, retirement and resilience, death and bereavement, cultural
competence in healthcare, and sexuality, there is increasing awareness of needs and resources to
aid an aging population. Planning services and programs that encourage advocacy is strategic.
Even though becoming elderly seems grim, within every realization, learning how to physically,
spiritually and mentally cope and support aging is also increasing. Since getting older affects
everyone, it is appropriate to discuss the cares and concerns of this population.

Agency Review:
Connecticut Center for Healthy Aging is based in the Bradley Memorial Hospital, 81
Meriden Avenue, in Southington, CT, and also located in New Britain General Hospital, 100
Grand Street, New Britain, CT. The website’s main page is easy to read plain blue and black text
on white background, while an image of a man and woman with a young boy, probably supposed
to be their grandson, walks happily on a beach, and illustrates a point that they feel good to be
alive and well.
The Mission Statement reads: “Connecticut Center for Healthy Aging is a resource and
assessment center designed to enhance access to services and information related to attaining
optimal quality of life for seniors and their caregivers” (http://www.cthealthyaging.org/aboutus).
Part of the Vision Statement informs that “The Center” will provide interdisciplinary
needs assessments, referral services based on needs and objectives, and serves as a conduit to
services such as medical care, social services, community resources, financial planning, elder
law advisors, as well seeking out programs to educate and care through grants. They also list a
“Values Statement” about objectivity, commitment to holistic care, collaboration with other
medical providers; have professional, respectful, and ethical decision-making.
Under the ‘Resources’ tab; there are images of senior health services continuum of care
and partners, with such facilities as: The Orchards of Southington; Jerome Home; VNA
Healthcare; Central Connecticut Senior Health Services; and more. Under the ‘Events’ tab, there
is mention of “Lunch and Learn” sessions at both locations, such as learning how to protect
yourself from identity theft. There is also a press release about that the Catalyst Fund of the
Community Foundation of Greater New Britain recently awarded Central Connecticut Senior

Health Services $10,000 of grant money to launch a mobile kiosk to serve seniors and their
caregivers in Berlin, New Britain, Plainville, and Southington. This idea was implemented
because there are some seniors who are isolated or unaware of available services, creating a
belief that there is of lack of accessible services. The mobile kiosk will visit grocery stores,
senior centers, health fairs and other public places in surrounding areas.
Continuing the use of community resources, the events calendar links to ‘Alliance
Advantage’ (http://www.allianceadvantage.org), a club dedicated to area residents and their
wellness, for ages 55 years old and over, and lists several necessary events and programs for
consideration of different issues affecting seniors and caregivers, such as: Blood Pressure
Screenings; Stroke Support Group; Strategies and Resources for Healthy Aging; a fitness group;
Caregiver Support Group; and others. The Alliance website also states that the benefits in
becoming a member are receiving newsletters and discounts to certain merchants.
In the ‘Contact Us’ tab, it shows a picture of Marc Levesque, M.S., Senior Resource Case
Manager, as well as his e-mail address. Both locations of the Connecticut Center for Healthy
Aging, in Southington and New Britain, are open Monday through Friday, 10:00am to 3:00pm,
though closed holidays, as well as weekends. However, appointments could be made for other
hours.
Although, seemingly complete as services to seniors and caregivers, there is no mention
of the availability or access to transportation to doctor’s appointments or events, or meals, as
other-type senior programs mention. Since they do access community resources, however, the
likelihood of these services probably do exist.

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